1) It is immunization day at the health center. The first patient is a 2-month old well female infant who is scheduled for the following vaccinations: pneumococcal conjugate vaccine (PCV), pentavalent vaccine (Penta) and oral polio vaccine. PCV and Penta are given via intramuscular route. Where are the sites of injection? What muscle is targeted in the injection? Write down its origin, insertion and action. How do you locate this area?
Considering the infant's age and scheduled vaccinations of pneumococcal conjugate vaccine (PCV), pentavalent vaccine (Penta) and oral polio vaccine, the most appropriate site is the vastus lateralis muscle in the anterolateral thigh.
Origin: Greater trochanter and linea aspera of femur.
Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament.
Action: All four heads extend leg at knee joint; rectus femoris muscle acting alone also flexes thigh at hip joint
To locate the area:
- Locate the greater trochanter of the femur
- Locate the top border (hand width below the groin) and the bottom border (hand width above the knee) of the vastus lateralis muscle
- Locate the side borders (mid anterior thigh to the mid lateral thigh)
Anywhere in the middle part of the located area is an ideal site for injection.
2) The baby’s 65-year-old grandfather also came to the center because influenza vaccine is being offered to senior citizens. The flu vaccine is given intramuscularly. Which muscle is the preferred site for IM injection in this case? Write down its origin, insertion and action. How do you locate this area?
For the 65-year-old patient, the most appropriate site for IM injection of flu vaccine is the deltoid muscle
Origin: Acromial extremity of clavicle (anterior fibers), acromion of scapula (lateral fibers), and spine of scapula (posterior fibers).
Insertion: Deltoid tuberosity of humerus.
Action: Lateral fibers abduct arm at shoulder joint; anterior fibers flex and medially rotate arm at shoulder joint; posterior fibers extend and laterally rotate arm at shoulder joint.
To locate the area:
- Locate the acromion process by palpating the bony prominence from the shoulder.
- Place three fingers below the acromion process.
The ideal injection site is located three finger widths below the acromion process, where the middle of the deltoid muscle is located.